title: Preoperative gemcitabine-based chemoradiation therapy for resectable and borderline resectable pancreatic cancer.
abstract: OBJECTIVE
  To evaluate the outcome of preoperative gemcitabine-based chemoradiation therapy (CRT) for resectable and borderline resectable pancreatic cancer (PC), with a focus on the differences in surgical outcomes and patterns of recurrence between these 2 categories.
  
  
  BACKGROUND
  Various multimodal treatment strategies have been proposed to improve the surgical outcomes of PC. Preoperative CRT and subsequent surgery is one of the promising strategies for resectable (PC-R) and borderline resectable (PC-BR) PC.
  
  
  METHODS
  A total of 268 patients with PC-R and PC-BR received preoperative gemcitabine-based CRT. The numbers of PC-R and PC-BR cases were 188 and 80, respectively. We evaluated the following comparisons between patients with PC-R and those with PC-BR: (1) resection rate, (2) rate of margin-negative resection, (3) survival, and (4) pattern of the treatment failure, including local recurrence, peritoneal dissemination, and distant metastasis.
  
  
  RESULTS
  The resection rate of patients with PC-R (87%) was higher than that of patients with PC-BR (54%) (P < 0.001). Pathological margin-negative resection was achieved in 99% and 98% of the patients with PC-R and PC-BR, respectively. The 5-year survival rates of the PC-R and PC-BR cases were 57% and 34%, respectively (P = 0.029). Although the 5-year cumulative incidence of local recurrence was comparable in both groups (15% and 13%, respectively; P = 0.508), the 5-year cumulative incidence of peritoneal and distant recurrence was significantly higher in the patients with PC-BR (43 and 76%) than in the patients with PC-R (17% and 43%).
  
  
  CONCLUSIONS
  In the resected cases, the locoregional control was comparable between patients with PC-R and PC-BR after preoperative CRT. The survival rate for the patients with PC-BR was lower than the rate for those with PC-R due to a higher incidence of peritoneal and distant recurrence in the patients with PC-BR. (UMIN000001804).
authors.affiliation: Departments of *Surgery †Diagnostic Radiology ‡Cancer Survey §Gastroenterology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Takahashi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ohigashi
authors.forename: Kunihito
authors.initials: K
authors.lastname: Gotoh
authors.forename: Shigeru
authors.initials: S
authors.lastname: Marubashi
authors.forename: Terumasa
authors.initials: T
authors.lastname: Yamada
authors.forename: Masayuki
authors.initials: M
authors.lastname: Murata
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ioka
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Uehara
authors.forename: Masahiko
authors.initials: M
authors.lastname: Yano
authors.forename: Osamu
authors.initials: O
authors.lastname: Ishikawa
mesh_terms: D000368:Aged; D000465:Algorithms; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D059248:Chemoradiotherapy; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery / Q000628:therapy*; D011300:Preoperative Care; D011446:Prospective Studies; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine